Publications

 

 

 

I

ntroduction

Much success has been achieved in practice with patients who undergo posture resistance therapy according to the Bugnet method (see chapter 3.1). The client sees many positive effects in practice. The method has not been scientifically substantiated but this literature research will look at articles describing static exercising and its effect at a neurophysiological level: what is the effect of static training on muscles, muscle fibre and tendons and on vital functions such as blood pressure, heart rate and breathing?

 

Much use is made nowadays in physiotherapy of dynamic training. What is the difference between static and dynamic exercising? Have other methods which make use of the same ideas and principles as the Bugnet method been investigated? Main and sub-questions have been formulated at the beginning of the literature research:

 

Main question:

-       Can the Bugnet method be explained by means of biological and neurophysiological mechanisms and, if so, what are they and how do these mechanisms work?

Sub-questions:

-       What is the basis of the Bugnet method?    

-       How does the Bugnet method effect the muscles/capsules/ligaments?

-       What is the difference between static and dynamic training?

-       What is the effect of static training on the vital functions?

-       Are there any other methods on the same basis that have already been researched?

-       Does the Bugnet method fit in with the new insights into motoric learning?

 

Besides the literature research, a status examination and treatment was also carried out on a patient with thoracic spinal column en shoulder complaints and chronic posture deviation. We as research group expect to find that static exercising provides qualitative better feedback between the nervous system and the muscles than dynamic training.

 

Keywords: Isometric exercising – vital functions – co-activation - stability

 

M

ethod

Requirements have been formulated to enable well-founded conclusions in order to substantiate the Bugnet method with scientific literature.

 

Literature research

The literature research is aimed at the databases made available for use by the Leiden College of Advanced Education. Requirements for the literature were set up while the strategy plan was being formulated. The literature must be no older than ten years. The articles must correspond as much as possible with the central PICO rule (chapter 4.2 to 4.6). The articles should be scored using the CBO guideline (see chapter 4.1) for use. Books complying with the same requirements as above have been used, as well as scientific articles. Literature older than ten years which does not fully comply with the PICO rule will be permitted if it emerges that there as insufficient other research meeting the criteria. The following search machines were used for the literature research:

-       Pubmed

-       PEDro

-       Medline

-       CINAHL

-       Cochrane Library

-       PsycINFO

 

Descriptions of the search strings and the PICO rule used are given below per sub-question.

 

What is the basis of the Bugnet?

The client was frequently consulted during the search for information about the effects and principles of the Bugnet method. Search strings have been put together on the basis of these meetings and reading the literature:

-       Muscle spindle

-       Fusimotor activation

-       Firing rates

-       Postural reflexes

-       Muscle co-activation

-       Co-contraction

In combination with the following words

-       Isometric training

-       Isometric exercise

-       Static training

-       Static exercise

-       Stretch reflex

-       Co-activation

 

PICO rule

P:         Young (sporty) test subject

C:         Dynamic training

O:        Greater activation of motor neurons, fusimotor neurons/muscle spindles

See chapter 4.6 for flow chart.

 

Effect on muscles, capsule and ligaments

The following terms were used when searching for articles:

-       Tendon

-       Muscle

-       Ligaments

In combination with the following words

-       Isometric contraction

 

PICO rule

P:         Test subject between 18 and 60 years old.
I           Isometric training or contraction
C:         Dynamic training or contraction
C:         Tendons/ligaments/capsules

See chapter 4.6 for flow chart.

 

Difference between static and dynamic training

The following terms were used when searching for articles:

-       Motor units

-       Proprioceptive

-       Motor unit firing rate

-       Muscle spindles

In combination with

-       Isometric contraction

-       Isometric training

-       Static contraction

-       Isometric and dynamic

 

PICO rule

P:         Test subject between 18 and 60 years old.
I           Isometric training or contraction
C:         Dynamic training or contraction
C:         Strength/stamina/ muscle length/muscle volume/coordination

See chapter 4.6 for flow chart.

 

What is the effect of static training on the vital functions?

The following search terms were used:

-       Breathing

-       Breathing pattern

-       Heart rate

-       Blood pressure

In combination with:

-       Static exercise

-       Static training

-       Isometric exercise

-       Isometric training

 

PICO rule

P:         Young (sporty) test subject

C:         dynamic training

O:        improved/deteriorated breathing, blood pressure and heart rate

See chapter 4.6 for flow chart.

 

Are there any other methods on the same basis?

The following search terms were used:

-          Pilates (effects of)

-          Core Stability Training

-          Caesar therapy (Caesar – therapy)

-          Stabilizing exercises (O’Sullivan)

In combination with:

-          Dynamic training

-          Static training

-          Postural stability

-          Posture stability

-          Core stability

-          Trunk stability

-          Trunk muscle training

-          Dynamic stability

-          Co-contraction

-          Posture resistance

-          Posture deviations

-          Neuro-muscular control (posture)

 

PICO rule

P:         Improved posture by means of an exercise programme

C:         Bugnet method, young adult

O:        Training programmes with the same effect as Bugnet (posture improvement, trunk stability)

See chapter 4.6 for flow chart.

 

Does the Bugnet method fit in with the new insights in motoric learning?

-       Motor skill learning

-       Motoric learning

In combination with:

-       Instructional theories

-       Engram theory

-       Schema theory

-       Ecological theory

-       Indirect / direct learning

-       Implicit / explicit learning

-       Knowledge of performance

-       Knowledge of results

-       Variable exercising

-       Neuro-physiology

-       Sport-oriented (motoric learning)

-       Learning phases

 

Status examination

A young active patient with chronic back and shoulder complaints was chosen. The patient's symptoms were first recorded in a case history. The patient was asked to provide her records from previous practitioners for the case history (see appendix 2.1). She was then examined (see appendix 2.2). The results of the examination were discussed with the practitioner and a treatment plan (see appendix 2.4) was set up. The patient went to the physiotherapist once a week for six weeks to check the exercises and to learn new ones. All the exercises were performed three times a day.

 

R

esults

 

 

1. What is the basis of the Bugnet method?

Bugnet posture resistance therapy is a method of treatment based on the ability and tendency of people to maintain a certain body posture in the presence of outside forces. Maintaining the posture is a neuro-physiological fact and develops as a reflex via the depth sensibility. Human posture reflexes are employed and applied with a therapeutic goal in Bugnet posture resistance therapy method. This is realised by the patient taking/being put into a certain position and asking the patient to progressively build up the resistances in the body. There is no movement during the exercises but there is talk of isometric contractions using the whole body.

 

Isometric exercising via α-activation²

The external pressure is too great to allow the muscle to contract in an isometric contraction. The muscle tension and the Ib activity therefore increases, however the muscle length remains the same. This combination highlights the fact that an obstacle (resistance) impedes movement and that tension has to be increased in order to realise a movement.

 

γ-activation² (gamma activation)

No mechanical effect (movement) in the extrafusal muscle occurs. The ends of the muscle spindle cells contract and the middle part is stretched which causes the Ia activity to increase; the reflective result of this is activation of the alpha-neuron so that the muscle contracts: contraction via the so-called gamma loop. The muscle is set at a shorter length by gamma activation. Deviations around this new setting are corrected via the Ia reflex.

 

Isometric contraction via α-γ-activation²

The external pressure is too great to allow the contraction. Contrary to that described above, the Ia activity now increases (the muscle spindle has become more sensitive due to the gamma-activation while the contraction ‘did not work’). The increased Ia activity stimulates the alpha-motoneuron so that the tension is increased and the resistance can be overcome. This means that movement (contraction) occurs when the Ia activity can be kept at the resting value. The extra activation of the alpha-neurons then stops. An isometric contraction changes to a isotonic contraction via this system of linked alpha and gamma activity.

 

Posture from the central nervous system

Facilitating reticulospinal pathway: this originates mainly in the pontine part of the reticular formation near the source of the vestibulospinal pathways. This pathway influences the α and γ motor neurons and particularly facilitates the flexion tone of the arms and the extension tone of the legs, in other words the typical human anti-gravity posture. This pathway system is also called the DRAS, (descending reticular activating system). It is a descending system that makes the muscles alert. The pathway runs as follows: muscle spindle – rising pathway in spinal marrow – reticular formation – descending pathway – gamma neuron- muscle spindle. The influence of the psyche on muscle tension comes about via this system. Balanced activity in this tone-regulating circle is a condition for adequate and stable posture^.33. To summarise: an isometric contraction ensures an extension of the equatorial part of the intrafusal fibres, resulting in a higher impulse frequency than, for example, is the case during an isotonic contraction. The gamma-activity is influenced from the reticular formation.

 

Art. 1 Evidence from proprioception of fusimotor co-activation during voluntary contractions in humans³ - Research by J. Trevor et al. (2007) concludes that the rest potential is increased by the elasticity of the intrafusal muscle fibre. It is suggested that when a muscle and its fibres have been conditioned and the muscle has to bear a load, the load bearing ensures that the play in the muscle disappears as a result of fusimotor co-activation.

 

Art 2. Training-related adaptations in motor unit discharge rate in young and older adults⁴ - From research by G. Kamen et al. (2004) into the motor unit activity in isometric exercises of the m. vastus lateralis, it emerged that there was an increase in the number of activated motor units. The exercises were carried out at 10%, 50% and 100% MVC (maximum voluntary contraction) at two different moments. The research took up a period of six weeks. There was a significant increase in the maximum strength (29% and 36% in younger and older adults respectively); this was accompanied by an increase in the activated motor units. The maximum activated motor units were 15% higher in young adults and 49% in the older adults; this applies to the 100% MVC. No differences were measured at 50 and 10% MVC.

 

Art 3. Maximal motor unit firing rates during isometric resistance training in men⁵-From research by A. R. Pucci et al. (2006), it emerged that when the training group and the control group could produce the same force at the beginning (training group 95.7±1.83% and control group 94.3±0.997%), there was a small but significant difference after 3 weeks. The training group now had an MVC of 98.44±0.658% and the control group 96.8±1.3%; (P <0.005). The level of the activated single motor units was significantly higher; 75% as opposed to 50% and 100 % as opposed to 75% MVC (P <0.05).

 

Conclusion

It can be concluded from the above that the equatorial intrafusal fibres are stretched during isometric exercises. Using the articles as proof, it can be shown that it is plausible that more motor units are activated by isometric tightening. This difference is measured at 100% MVC; it is not measured at 50% and 10% MVC. It is also highly likely that isometric training produces a significant rise in the maximum strength.

 

2.  What effect does the Bugnet method have on tendons?

From research by Kubo it emerges that isometric training significantly increases the volume and maximum contraction¹² of the quadriceps femoris muscle. The relationship between the calculated muscle strength and the length of the muscle tendon was more than 550N at various force levels and was significantly lower than after the training. After isometric training the rigidity of the tendon increased (Young modulus) from 67.5 N to 106.2 N. According to this research, isometric training increases the degree of strength development and reduces the electromechanical delay.

 

Conclusion

The results show that isometric training raises the rigidity of the muscle tendon, the Young modulus[1] of the tendon and also increases the strength and size. It is assumed that this change in the tendon is an advantage to the degree of strength development and the reduction of the electromechanical delay.

 

3.What is the difference between static and dynamic training?

 

Art 1. Isometric or dynamic training: differential effects on mechanical properties of a human muscle⁶- From research by J. Duchateau et al. (1984) it emerges that there is a difference between static and dynamic training and that muscles contract in different ways. An increase in the maximum contraction of the muscle could be seen in both static and dynamic training. The maximum contraction increased more after isometric training. Only the maximum contraction speed of the muscle increased after dynamic training, while isometric training showed a greater increase of the maximum strength (51% with static and 19% with dynamic training) and a shift in the optimal contraction strength as opposed to heavier loads.

Art. 2: Static versus dynamic training programmes for muscular strength using the knee-extensors in healthy young men⁷ - From research by L.O. Amusa et al. (1986) it emerged that muscle strength increases after both static and dynamic training, but that this increase is more with static training or isometric training.  

Art. 3: Effects of static and dynamic training on the stiffness and blood volume of tendon in vivo⁸ - From research by K. Kubo et al. (2008) it emerged that there was no significant difference in muscle volume of the m. Quadriceps after static and dynamic training. The MVC level increased significantly: by 49% with static training and by 31.5% with dynamic. The rigidity of the tendon increased significantly: by 55.1% with static training and by 30% with dynamic. The volume of blood in the patella tendon increased significantly after dynamic training but not after static training (See tables 1 and 2).

 

 

                       

Art. 4: Firing rates of motor units in human vastus lateralis muscle during fatiguing isometric contractions⁹- From the article by A. Adam et al. (2005) it emerged that activation of motor units is increased during isometric contraction when the strength is built up slowly and then remains constant. It also appears in the research that extra motor units are activated during the tightening phase in the case of isometric contraction. The motor units in all the test persons were activated quicker when activated by a second isometric contraction (see fig. 1 appendix 5). When new motor units are controlled during a contraction, it takes them longer to become activated than the "old motor units" that have already been activated.  

Art 5. Dynamic response of human muscle spindle afferents to stretch during voluntary contraction¹⁰- From research by Vallbo (1974) it emerges that more afferent muscle spindles are activated and that there is increased efferent activation of the muscle spindle and the muscle activity during isometric contraction. In this research 34 muscle spindles in the extensor carpi radialis brevis muscle were activated during isometric contraction. These afferent muscle spindles retained or increased their speed of activation during the isometric contractions. During dynamic contraction it emerged that 6 afferent muscle spindles even reduced their speed of activation.   

Art 6. Excitatory drive to the a-motoneuron pool during a fatiguing submaximal contraction in man¹¹ - From research by N. Wolfgang et al (1996) it emerged that the excitable activity of the triceps surae α-motor neurons pool muscle was increased during a continual isometric contraction of the plantair flexors in the foot. It was thought that this was a compensating mechanism to address new, tireless motor units and/or to raise the number of motor units. This was demonstrated by H/Mmax (measurements of muscle and reflex activity) and EMG r.m.s (root mean square) rising in all three muscles and by there being a reduced occurrence of cramp.

 

Conclusion
The proof from the articles above make the increases in maximum contraction and muscle strength occurring with static training plausible.

 

4. What is the effect of static training on the vital functions?

Breathing - It appears from the research by Louhevaara13 et al. (2000) that there is a great difference between dynamic and static training. Significant differences apply to both the breathing volume and the breathing frequency. The breathing volume was 0.89 ± 0.34 with the dynamic training and 1.14 ±0.32 with the isometric training. The breathing frequency was 20 ±6 with dynamic training and 15 ±5 with isometric training. The breathing volume and the breathing frequency is higher during dynamic training. (See table 3). Conflicting results have been booked for the effect of isometric exercise on breathing/drawing breath. Although research by Fontana et al. shows an increase in both breathing volume and breathing frequency, Muza et al report no significant changes during isometric exercise.

  

Blood pressure - Isometric exercise is associated with acute hemodynamic changes consisting of rises in the systolic, the diastolic, the average arterial pressure, the heart rate and the cardiac output¹⁴.

 

A meta-analysis¹⁵ (2010) of five controlled trials with a total of 122 subjects concluded that the systolic blood pressure dropped by 10.4mmHg and the diastolic blood pressure by 6.7mmHg after one hour of isometric exercise per week. These results indicate that isometric exercise could be valuable as part of a lifestyle change.

 

Research by Patrick O'Connor et al.16 (1989) shows that it is important to pay attention to the patient's breathing during isometric exercise. The research involved 3 groups. The first group (VAL, n=9) did the Valsalva manoeuvre during the isometric exercise, the second group (NON-VAL, n=9) were trained to breathe in when a contraction started and to breathe out during the contraction and the last group (CONT, n=9) were not instructed. See table 4

 

The result was that both the systolic and diastolic blood pressure of the first group rose during exercise but there was no significant change in the control group. There was a significant change to both the systolic and diastolic blood pressure of the second group.

 

Heart rate - In a study¹⁷ (2010) into isometric exercise and blood pressure, which also looked into the cardiac output, resting heart rate, systolic volume and the total peripheral resistance, a significant change appeared to occur.

 

The research involved four weeks of isometric bilateral leg exercise by thirteen persons with healthy blood pressure (average age 21.0 ± 2.4 years old: body mass 78.1 ± 18.2kg; height; 177.1 ± 4.6 cm). The persons had all been “averagely active" for at least three months before the study started. The result was that there was a drop in the resting heart rate (65 ± 11 to 58 ± 6 beats per minute¹⁷) besides a drop in the resting blood pressure. No significant changes were found in the cardiac output and the total peripheral resistance (the outflow via small arteries and arterioles).

 

It emerged from a study by M. Elstad et al. ¹⁸ (2009) into the cardiac output and total peripheral resistance, that both dynamic and static exercise lowered the stroke volume by 5–8%. This was accounted for by the increase in the average arterial pressure. The dynamic leg exercises doubled the femoral stroke volume and the static hand exercises lowered the femoral flow by 18%.

 

 

 

Conclusion

Based on the proof from the above research, it can be concluded that the isometric training has a positive effect on the blood pressure and heart rate. The effect on blood pressure relates to a reduction in both the diastolic and the systolic pressure.

Breathing is also of importance during exercise: breathing out during exercise lowers the blood pressure. Both the resting heart rate and the stroke volume are lower after isometric exercise.

 

There are conflicting results for the effect on breathing. However it does appear that there is a difference between static and dynamic training. No conclusions can be drawn from the results; this is because of the lack of proof from the relevant researches.

 

5.  Are there methods similar to the Bugnet method which have been researched?

 

The postural resistance therapy can be compared to other methods which have already been researched for the purpose of creating more clarity regarding the effects and functionality of the Bugnet method (see chapter 3.1 of the appendix for a description of Bugnet). It appears from the literature research that there are four methods aiming for the same effect as Bugnet, namely Pilates, Core Stability, Caesar therapy and an exercise therapy according to O’Sullivan. The four methods of treatment will be described in the next part and in the appendix and the efficacy of the methods will be described using literature research.

 

Pilates

Art.1 Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial¹⁹ - It may be concluded from research by Donzelli et al. (2006) that Pilates has a positive effect on lower back pain and posture improvement in comparison with the Back School method which is highly prized in America. The back school method lays the emphasis on information, mobilisation and training muscle function.

 

Art.2 The effects of a Pilates training programme on arm-trunk posture and movement²⁰ - It can be concluded from research by Emery et al. (2010) that Pilates has a positive effect on the strength of the stomach musclature, the posture, strength and stability of the cervical and thoracic spinal column and shoulder during flexion movement of the shoulder.

 

Art.3 Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial²¹ - It can be assumed from research by Rydeard et al. (2006) that a Pilates treatment is efficacious for treating chronic lower back problems, where the emphasis lies on neuromuscular control of the muscles, pain and functionality.

 

Art.4 The influence of Pilates training on the ability to contract the transversus abdominis muscle in asymptomatic individuals²² – Research by Herrington et al. (2005) shows that an increase in the ability of the transversus abdominis muscle to contract occurs with Pilates training, as a result of which better lumbar stability is achieved and better posture maintained.

 

Art.5 The effectiveness of the Pilates method: reducing the degree of non-structural scoliosis and improving flexibility and pain in female college students²³ - Research by Araujo et al. (2012) shows that Pilates helps to reduce the degree of scoliosis.

 

Link to Bugnet method

After comparison with the Bugnet method it can be said that both Pilates and the Bugnet method aspire to better body balance. Pilates is oriented towards yoga, lifestyle, fitness and awareness. The Bugnet method chiefly uses co-contraction and chain operation in the entire body with a therapeutic goal. Resistance is used and posture reflexes utilised. The exercises in the Bugnet method are carried out in a static position while Pilates uses static exercises which are dynamically developed.

 

Research into O’Sullivan

No clear²⁴ judgement can be made from research into the effect of this type of exercise (see appendix 3.6.2). There is little proof in the research so the results cannot be considered plausible. When this method of treatment is compared to the Bugnet method, it can be said that stability of the lumbar spinal column is chiefly acquired with the O’Sullivan method while the Bugnet method is aimed at stability of the entire body with the aim of activating the weaker parts.

 

Core stability

Art.1 A systematic review of the effect of core training for a-specific chronic low back pain – with an attached protocol for training these patients²⁵ - It can be concluded from a literature study (2009) done during this research that Core Stability training has a positive effect on the pain experienced by persons with lower back problems. Moreover the reduction in pain and the ability to take part in more activities ensures a better quality of life.

 

It can also be concluded that static training of the stomach and back musculature increases the strength and stamina of the trunk. Core Stability training not only improves the quality of life and reduces pain but also has a preventive effect, as a result of which the number of persons with lower back problems can be reduced.

 

Link to Bugnet method

When Core Stability training is compared to the Bugnet method, a number of common characteristics can be seen. Both Core Stability training and the Bugnet method strive for static flexion of the muscles and co-contraction takes place during the exercises. Core Stability training only aims at stability of the trunk while the Bugnet method exercises the whole body.

 

Cesar therapy

Art.1 Cesar therapy is temporarily more effective than standard treatment by the general practitioner for patients with chronic a-specific lower back problems; randomised, controlled and anonymous research with one year follow-up²⁶- Research by Hildebrandt (2000) shows that Cesar therapy has a favourable effect on lower back problems. In respect to the standard treatment, the therapy only appears to be effective in the short term and is less effective in the long term.

 

Art.2 The patient with referral for lower back problems without radiating pain in practice for Cesar exercise therapy²⁷ - Research by I.C.S Swinkels et al. (2004) shows that exercise therapy according to Cesar appears to be effective for a large number of patients with lower back problems without any radiating pain. There is however talk of a long period of treatment.

 

Link to Bugnet method

As is the case with the Bugnet method, Cesar therapy aims at treating and reducing posture deviations. Cesar therapy uses dynamic exercises to reduce the posture deviations as opposed to the Bugnet method which uses static exercises. Contractures are stretched and weaker muscles are strengthened during static Bugnet exercises so that new body balance can be developed.

 

Conclusion

It can be concluded from the treatment methods above that there are various methods for treating posture deviations and instability problems which all ultimately aim at the same result. A conclusion cannot be made about the actual effect and efficacy of Core stability training and the O’Sullivan exercise therapy on account of the often small amount of proof available. However it can be concluded that there is a rich diversity of both dynamic and static exercises aimed at improving the balance and stability of the body. A comparison cannot be made between the various other methods and the Bugnet method using the literature found.

 

6. Does the Bugnet method fit in with the new insights into motoric learning?

It is taken for granted in motoric learning that various techniques, movements and/or taking positions are learnt, consciously and unconsciously. Instructions are needed to learn these motoric skills (how the exercises should be performed) and consciousness and experience are of great importance. The Bugnet method also uses motoric learning. The execution of a number of motoric skills in the form of static exercises is aimed at and they are learnt by means of both direct (instructions about the execution) and indirect learning (positive effects and experiences in respect to the complaints). The patient is placed in exercise positions which facilitate the sense/experience learning and in which posture reflexes play an essential role in motoric learning. This underlines that fact that the Bugnet method makes use of the principles of motoric learning.^{28,29,30,31,32}

 

Status examination

When the research data and the feedback from the patient was compared, it emerged that there was definite progress in day-to-day functioning and a reduction in the pain. The scoliosis seems less, the open spaces between arm and thorax are more equal, the reference points on the pelvis are at equal heights and the arm muscle strength of the patient has significantly improved.

The patient indicated that everyday movement is easier and also gives the following activities a lower pain rating by means of VAS: remaining in the seated position for a long time was a 9 and is a 6 at the moment, the patient gave overarm movement an 8 and now a 4, tennis which is an important part of the patient's life first scored a 7 but now a 3. The greatest progress was made in lifting and hair-combing (from 10 to 5 and from 8 to 0 respectively). Pain occurs less frequently and recovery is also quicker.

 

Conclusion

Compared to previous treatment, Bugnet appears to have a more positive effect on everyday life and on sporting activities. The patient experiences fewer symptoms and less pain within 7 weeks, after 6 treatments and a schedule for home exercising.

 

D

iscussion

 

The following problem definitions were investigated in the literature research: what is the basis of the Bugnet method and what effect does it have on a neurophysiological level? As a result of the practical counsellor's experience, it was expected that that the principles of the Bugnet method could be explained on scientific grounds would emerge from the literature research. It was also expected that the relevant patient would experience an improvement in the symptoms after treatment according to the Bugnet method and that the reduction of symptoms could be (partly) explained in the literature research.

 

The research does show that it is likely that static/isometric training, which forms the basis of the Bugnet method, has a positive effect on the number of activated motor units and on the maximal strength of the muscles. The research also shows that there is an increase in the rigidity of the tendon after static/isometric training. When the effect of isometric training on the vital functions was examined, it appeared that the resting heart rate, the systolic and the diastolic blood pressure all dropped.

 

Recommendation: Further research for the purpose of ratifying the results could be aimed at the effect of isometric training on general everyday functionality. It was noticeable in the literature research that a relatively small research population had been used and that a number of relevant articles had not been published recently (publication date earlier than 10 years ago).

 

As well as neurophysiological literature research, methods were also investigated that use similar principles to those of the Bugnet method. It emerged from the research that there are four methods which show similarities to the Bugnet method. However these similarities are insufficient and the differences are too great (target groups and/or training methods) to enable a judgement to be made about the effect of the Bugnet method. Recommendation: Further research could be carried out into the Bugnet method itself, aimed towards measuring coordination, muscle strength and general everyday functionality.

 

Attention has also been paid to the newest developments in motoric learning and how Bugnet fits in with this. It shows that the application of the Bugnet method makes use of the direct and indirect learning of motoric skills. This method of treatment also makes use of the ability of the person to retain a certain posture against external forces. The method has therefore been called posture resistance therapy since 1968. Bugnet neuromyotherapy was the original name which alluded to the working of.... and to the nervous system and the muscles.

 

Besides the literature research, a status examination was also conducted which looked at the treatment of a patient with posture-related symptoms by the Bugnet method. The patient experienced a significant reduction of the complaints after 6 weeks of treatment.

Similar research is recommended with a larger patient population, whereby the results will be evaluated by means of the PSK and VAS, or by other measuring instruments.

 

Literature list

See appendix 4.7 f the proof per article

1. http://stichting-bugnet.eu/index.php?option=com_frontpage&Itemid=1
2. Dr. B. van Cranenburgh, Schema’s fysiologie - fysiologie, Pathofysiologie, Neurowetenschap, Vierde, herziene druk, 1997 Elsevier/De Tijdstroom, Maarssen, chapter 28
3. Trevor J. Allen, Gabrielle E. Ansems and Uwe Proske, Evidence from proprioception of fusimotor co-activation during voluntary contractions in humans, Department of Physiology, Monash University, Clayton, Victoria 3800, 2007 Australia
4. Kamen G; Knight CA, Training-related adaptations in motor unit discharge rate in young and older adults, The Journals Of Gerontology. Series A, Biological Sciences And Medical Sciences [J Gerontol A Biol Sci Med Sci] 2004 Dec; Vol. 59 (12), pp. 1334-8.
5. A. R. Pucci1, L. Griffin2 and E. Cafarelli1, Maximal motor unit firing rates during isometric resistance training in men, Experimental Physiology [Exp Physiol] 2006 Jan; Vol. 91 (1), pp. 171-8. Date of Electronic Publication: 2005 Oct 06
6. J. Duchateau and K. Hainaut, Isometric or dynamic training: differential effects on mechanical properties of a human muscle, Journal of Applied Physiology February 1, 1984 vol. 56 no. 2 296-301
7. Amusa LO, Obajuluwa VA, Static versus dynamic training programs for muscular strength using the knee-extensors in healthy young men. J Orthop Sports Phys Ther. 1986;8(5):243-7.
8. Keitaro Kubo Toshihiro Ikebukuro, Katsutoshi Yaeshima, Hideaki Yata, Naoya, Tsunoda and Hiroaki Kanehisa, Effects of static and dynamic training on the stiffness and blood volume of tendon in vivo, J Appl Physiol 106:412-417, 2009. First published 26 December 2008; doi:10.1152/japplphysiol.91381. 2008
9. Alexander Adam and Carlo J. De Luca J, Firing rates of motor units in human vastus lateralis muscle during fatiguing isometric contractions, Appl Physiol 99:268-280, 2005.Doi:10.1152/japplphysiol.01344.2004
10. Naoyuki Kakuda and Masanori Nagaoka , Dynamic response of human muscle spindle afferents to stretch during voluntary contraction, Department of Neurology, National Rehabilitation Centre for the Disabled, Namiki 4-1,Tokorozawa, Saitama 359-0042, Japan (Received 5 May 1998; accepted after revision 9 September 1998)
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